Healthcare Provider Details

I. General information

NPI: 1083864037
Provider Name (Legal Business Name): HEALTH SPECIALISTS OF DAYTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST STE 3110 BERRY PAVILION
DAYTON OH
45409-2722
US

IV. Provider business mailing address

1 WYOMING ST STE 3110 BERRY PAVILION
DAYTON OH
45409-2722
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6800
  • Fax: 937-208-2139
Mailing address:
  • Phone: 937-208-6800
  • Fax: 937-208-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH PRUNIER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 937-208-8213